Family Case Analysis 2

ANGELES UNIVERSITY FOUNDATION

Angeles City

In Partial Fulfillment of the Requirements in Related Learning Experience

COMMUNITY HEALTH NURSING:

FAMILY CASE ANALYSIS

“An Assessment of Griffin Family in Barangay Sapalibutad”

Presented by:

GROUP 1- BSN III-1

ANO, CARL ELEXER

CALMA, ARIANE CAMILLE

DIZON, REQUELITO

SOTTO, MICHELLE LOUIE

BALILO, NOEL LEONCIO

CABRERA, KRISTINA EDNA

CUYUGAN, MARY ANN

DE JESUS, LUIGI MIGUEL

ESTRADA, FLORENCE ANCEL

LIBRES, MARY ANGELICA TEOFFY

PALCIS, DANIEL

VALENCIA, PRECIOSA

Presented to:

JOANNE MARIE GALANG, R.N.

I. INTRODUCTION

A family is a unit composed not only of children but of

men, women, an occasional animal, and the common cold.

~Ogden Nash

Ogden Nash was basically a humorist, but such quote made a lot of sense. To interpret

it, it must mean that the family is a model which, physical manifestations would include the

presence of a man one calls father, a woman one calls mother, and of course those sons and

daughters running about to get their tasks done as they, undeliberately, grow older. A sleeping

dog or a cat basking on the sunlight at the patio would constitute to the occasional animal he

was talking about. And as for the common cold, generally, this would mean a highly contagious,

self-limiting disease brought about by different strains of viruses with symptoms of sore throat,

runny nose, nasal congestion, sneezing and coughing.

So how did common cold get to associate itself with the family? One would say, its

communicability is the primary factor, yes. Looking beyond the natural scope of things, the

predetermined communicability of the common cold lies on the word, common, not as of the

ordinary, but as of the shared. Usually, in a family, if one child is coming down with a cold,

surely, a sibling will follow, especially if such come from a depressed family devoid of the

advantages of nutrients to keep their immune system on the pink of health. Perhaps Nash was

only trying to imbibe to us the power of family, that even diseases are shared. A loving family is

worth all the riches in the world, for they will always be there for you, no matter what happens.

Ergo, no poor family is too poor if they have a family deeply rooted in love and compassion for

each other.

On a more serious note, In Article 15: The Family, of the 1987 CONSTITUTION OF THE

REPUBLIC OF THE PHILIPPINES: “The State recognizes the Filipino family as the foundation

of the nation. Accordingly, it shall strengthen its solidarity and actively promote its total

development. This reinforces the value of the family in community health nursing, as it plays

mediator between the first and third type of clientele, the individual and the society.

The family, being the crucial entity of the society is also deemed as the critical unit of

care since it is an efficient and accessible avenue for much of the community health nursing

effort. How ironic to say that a family shares a disease to be family! As aspiring nurses, it is the

duty of the researches to at least, be there for the family to reinforce health goals and promote

self-reliance, that it’s a deliberate nature of the family to share, yes, but not illness. Family

Health Nursing is a level of community health nursing practice focused or directed on family as

the unit of care/ client, with health as a goal and nursing as a medium or provider of care.

Family-centered care is the key concept in community health nursing practice.

Family Case Analysis is an instrument utilized by PHN nurses and student nurses alike

in delineating all prevailing problems of the community by centering on the families constituting

it. Home visits are the number one means in order to accomplish this. In here, the family’s

health needs will be assessed and the nurses, or the student nurses, rather, will provide health

teachings and render nursing care to accommodate and address their inadequacies and

liabilities in terms of family life and do something about them.

Before the exposure, the student nurses have a main criteria in choosing a family as a

subject; 1.) Depressed, 2.) Lack knowledge about healthy lifestyle, 3.) At least four members of

the family, 4.) At least have children who are 7 years old and below and the Griffin family suits

are criteria the most. They cannot do health tasks effectively making them at risk with different

health hazards.

FCA is a tedious and painstaking requirement but it is rewarding enough as it is. It

served as a wakeup call for all student nurses, making them witnesses of the poverty and

decreasing self-reliance when it comes to healthcare which are becoming ubiquitous in the

community at present.. The plain fact that the student nurses were given an opportunity to help

these people and make them happy made all working days worth their while.

A. Objectives

a. Short Term: Student Centered

After 2 days of home visit to Barangay Sapalibutad, the student nurses will:

Familiarize themselves with the physical surroundings of the community.

Choose a family that would serve as the center of study for the family case analysis.

Introduce oneself to the family and stating their purpose and methods.

Obtain consent from the family allowing the student nurses to conduct a study.

Establish rapport to the chosen family.

Gather and obtain pertinent data including demographic, socio-economic, cultural, and

environmental data.

Educate the family in the promotion of health and prevention of illness.

Obtain individual health data by:

Perform health assessment to each family member (IPPA-Cephalocaudal).

Gather the following information: Mother’s obstetrical history.

Assess the growth and development of the children and their immunization status.

Gather and obtain each family’s nutrition status by age, weight and height.

Gather information about family’s history and present illnesses.

Acquire data regarding the family’s activities of daily living.

Identify the existing and potential problems that may affect and aggravate the

family’s health status based on the data gathered.

b. Short Term: Client Centered

After 2 days of home visit, the family will:

Demonstrate understanding regarding the purpose of home visits to be conducted by the

student nurse.

Provide complete and necessary information in relation to all the family members’ history

of past and present illnesses, their activities of daily living and their nutritional status,

socio-economic, cultural and environmental conditions, sincerely.

Identify the health problems present in their family.

Acknowledge the services rendered by the student nurses.

Establish rapport with the student nurses.

c. Long term: Student centered

After 2 weeks of home visit, the student nurses will:

Apply the therapeutic communication skills during the interview and gain the cooperation

of the family.

Understand the health planning situation and health practices of the family and use

these as basis in analyzing and planning future nursling interventions.

Identify and prioritize the health problems jointly with the family.

Formulate a family coping index.

Plan with the family to solve the identified health and nursing problems.

Implement nursing interventions and provide health teachings.

Encourage every member of the family to participate in the health programs (activities

initiated by the student nurses).

Help the family realize the importance of availing health services provided by the

community (Brgy. Health Center).

Evaluate family’s response to the interventions and health teachings given.

Reinforce interventions and health teaching if there is a need.

d. Long Term: Client Centered

After 2 weeks of home visit, the family will:

Identify the health problems present in their family.

Realize the importance of having and maintaining good health practices.

Prioritize the identified health problems.

Identify the ways or the appropriate actions to meet their health needs and health

problems.

Comply with the health teachings rendered by the student nurses.

Maintain an environment that is conducive to health and development.

Demonstrate continuous compliance with the health teachings given even after student

nurses’ community exposure

B. Entry, Climate of acceptance, first few words

Group 1’s 4th rotation is in the community of sapalibutad. It is the group’s Second

time duty in a community setup but 1st time being in the community of sapalibutad,

Although not so quite familiar, the group was able to adopt the environment and cope up

with the people of the community.

Feb 25, 2009 – Wednesday, it was the first day of encounter with the family to

adopt for family case analysis. The group scouted the community with eager of knowing

the family for their F.C.A. The group went to walk the streets with the sun raised very

high to find their family. Although it took a while, the group was able to arrive with a

family that passed the criteria for family case analysis accidentally. It was actually the

family’s neighborhood that the group is expecting to adopt, but luckily was not there and

instead of acquiring the neighbor, the Griffin family’s mother lois (mother) said that their

neighborhood left. So instead the group asked the Griffin family if they ould be the

group’s adopt family for family case analysis.

“Gandng umaga po, Kame po ay taga AUF na naghahanap ng family na

puwedeng ma-adapt para sa FCA namen. Puwede po ba ang family niyo?” the group

said. “ah sige puwede halika pasok muna kayo” replied by the mother.”Salamat

po”comment by the group for accepting them by the family. “ Nay, ano po pangalan

niyo?” it was the first question asked by the group to start their assessment. The tension

and awkwardness ws immediately abolished and rapports was finally established, The

mother was very cooperative to the group, all possible questions were asked without

difficulties and able to answer all possible question asked. She even assured the group

that they could visit their family case analysis.

Number of home visits:

First home visit:

Feb 25, 2009 – Wednesday, it was the first time that the group students will meet

their family. They initially started their establishment of rapport by greeting their family

warmly, introducing each of the members of their group and explaining to the family their

purpose for the visit. The group also identified each members of the family and tried their

best to get the trust of the family members. They started questions regarding the needed

information data including demographic data, socio-economic and cultural data of he

family. The group also gathered the mother, and her son and daughter baseline data

assessment without the father because of working time. The group initially identified

initial few family problems and conducted a schedule when to come back and to make

appropriate appointment for the assessment of the father.

Second home visit:

Feb 26, 2009 – Thursday. The 2nd day of the home visit. The group went to their

family and greeted the family warmly as they entered the house. The group was able to

meet the father of the family because if the set time for meeting. The group was able to

assess the father and clarify more things to obtain more specific and reliable data. The

group assessed each family members cephalocaudaly for P.A. Each member is very

cooperative during the assessment. The group assessed and identify further family

problems.

Third home visit:

Feb 27, 2009 – Friday, The 3rd day of home visit. The group finalized family

problems and obtain data of the living place including windows size measurement, floor

plan, house measurements and other data that is relevant for family case analysis, and

also the group was able to implement interventions for the family. And able to plan more

interventions for future home visit and identify more problems, if any. The group also

planned to which is the things needed by the family for their daily livings.

Fourth home visit:

March 4, 2009 – Wednesday. The 4th day of home visit. The group continued

intervention implementation for the family improvement and also conducted health

teaching for the family regarding health and wellness. The group was able to contribute

things for daily living that would aid the family towards wellness. The group was able to

improve their family hygiene by providing health hygiene kits.

Fifth home visit:

March 5, 2009 – Thursday. The 5th day of home visit. The group continued for

the interventions needed by the family. The group was again aided the family for hygiene

practices by assisting each family members and conducting health teachings. The group

prepared for the future home visit to evaluate the implemented intervention and also to

identify the improvements of the family and Evaluation followed.

II. Family Constellation

Name Age Position Sex Educational Status Present health statusBrian Griffin

32 yrs. old

Father Male High School(4th yr

Undergraduate)

Upon assessment Brian Griffin was wearing a yellow long sleeved shirt black pants and a pair of black leather shoes, He is cooperative, coherent and oriented to time, place and person, he has steady gait and shows no difficulty recalling events. He looks exhausted. He stands 168 cm and weighs 63 kg, He has a BMI of 22.34 which is healthy weigh.VS are as follows:Temp: 36 cPR: 73 bpmRR: 21 bpmBP: 100/60 mmHgSometimes experience dizziness when standing after Prolonged rest.

Lois Griffin

45 yrs. old

Mother Female Elementary(Grade 3)

Lois Griffin was wearing a white shirt and pink pants, her hair is tied up. She is cooperative, coherent and oriented to person, time and place. She has a sense of reality, shows no difficulty recalling past event, she stands 155 cm and weighs 46 kg, her BMI is 19.17 which is healthy weigh.VS are follows:Temp: 36.5 cPR: 75 bpmRR: 17 bpmBP: 110/80 mmHgShe has difficulty hearing especially with the use of her right ear.

Meg Griffin

4 yrs old

1st born daughter

Female Never been to school

Meg Griffin was wearing a white shirt and green pants

and a pair of dirty slippers. She is unable to express herself through speech. She has a steady gait and unkept appearance. She stands 88 cm and weighs 9 kg.VS are as follows:Temp: 36.3 cPR: 89 bpmRR: 22 bpmOften Cough and colds with nasal discharge

Stewie Griffin

3 yrs old

2nd born Son

Male Never been to school

Stewie was wearing a white shirt and red shorts and a pair of slippers. He is unable to express himself through speech. He has steady gait. He stands 88 cm and weighs 10 kg.VS are as follows:Temp: 36.2 cPR: 90 bpmRR: 20 bpmEpisodes of cough and colds

III. HEALTH ASSESSMENT

To be a health educator, a community health nurse must be able to determine initially

any abnormalities or deviations from clients’ health. Assessing the health status of a client is a

major component of nursing care and has two aspects: (1) the nursing health history and (2)

physical examination. One way by which health status of the family can be assessed is through

physical examination using cephalocaudal approach. It is done using inspection, palpation,

percussion and auscultation to identify areas for health promotion and disease prevention.

Family assessment begins with a complete health history. It is one of the most effective

ways of identifying existing or potential health problems. History is followed by physical

assessment of family members (Kozier, 2004).

Assessment enhances identification of physical and psychological needs. The amount,

depth, and level of assessment skills vary with the knowledge and expertise of a nurse. Data

about the present condition or status of the family are compared against norms or standards of

problems.

1. BRIAN GRIFFIN

PHYSICAL ASSESSMENT

( February 25, 2009, Wednesday )

Vital signs:

T- 36 °C

P- 73 bpm

R- 21 cpm

BP- 100/60 mmHg

General Appearance and Mental Status:

During the assessment, Brian Griffin was wearing a yellow long-sleeved shirt, black

pants and a pair of black leather shoes. He is cooperative, coherent and oriented to person,

place and time. He has a steady gait and shows no difficulty in speaking. He also exhibits

thought association and has a sense of reality. He has no difficulty recalling past and present

events. He looked exhausted. He stands 168 cm and weighs 63 kg.

HEAD AND FACE

Head

His hair is black in color. It is evenly distributed and no presence of dandruff was noted.

No presence of infestations were noted.

Skull and Face

He has normocephalic skull and with smooth skull contour. No nodules and masses

were noted upon palpation. His face is symmetrical in shape and there is no abnormal elevation

or depression on the face.

Eyes

His eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also

evenly distributed. Skin is intact, no discharges and no discolorations are present at the surface

of eyelids. Lids close symmetrically. He has moist mucous membranes and her palpebral

conjunctiva is pink in color. His pupils constrict when looking at near objects while they dilate

when looking at far objects.

Ears

His auricles are same as facial color and it is aligned with the outer canthus of the eye.

They are mobile, firm and not tender upon palpation. Pinna recoils after it is folded. There is no

presence of impacted cerumen. He can hear and respond when he is asked.

Nose

His nose is straight and his septum is located in the midline. No deviations have been

observed in the shape, size and color of the external nose. No discharges were noted and there

is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation.

Lips and Teeth

Outer lips are symmetrical. He exhibits ability to move her lips. Inner lips and buccal

mucosa are uniform in color. He has a complete set of teeth and his tongue is in central position

and he can move it freely.

NECK

Neck Muscle

Neck muscles are equal in size. No masses and nodules were noted upon palpation.

Head movements are coordinated and he can move his head freely.

Lymph Nodes

Lymph nodes are not palpable and there is no enlargement noted upon observation and

palpation.

THORAX AND LUNGS

Lungs

There is full and symmetrical chest expansion. There is effortless and rhythmic

respirations and no adventitious breath sounds were heard upon auscultation.

Heart

Regular rhythm of apical pulse was noted upon auscultation.

Abdomen

No distention and presence of lesions and masses were observed. He has normoactive

bowel sounds.

Skin

He has brown-colored skin which is generally uniform except in areas of lighter

pigmentation such as the palms, lips and nail beds. No abrasions and edema have been noted.

He has good skin turgor, which turned back to previous state in less than 3 seconds when

pinched.

Extremities

Peripheral pulses are in full pulsations. Limbs are not tender and no edema is present at

extremities.

Fingernails

His nail plates are colorless and have concave curves. They are slightly long and

untrimmed. His nail beds returned to previous state in less than three seconds after pressure

was applied.

NUTRITIONAL STATUS

Age: 32 years old

Height: 168 cm

Weight: 63 kg

Formula:

Body Mass Index (BMI) = Weight in kilograms (kg) Height in meter squared (m2)

Body Mass Index (BMI) = 63 kg 2.8 m2

= 22.5Interpretation:

Healthy Weight

Legend:

BMI Table ( Based on Asia-Pacific Obesity Guidelines )

Underweight < 18.5

Healthy Weight 18.6-22.9

Overweight > 23.0

At risk 23.0-24.9

Obese I 25.0-29.9

Obese II > 30.0

HISTORY OF PAST ILLNESS

According to Brian Griffin, he had measles during his childhood. He stayed for almost

three weeks in the hospital. This was managed through medications and rest. He also had

episodes of convulsions accompanied by fever last 2003. First he was brought to a secondary

level hospital in Angeles City for a check-up, then he was confined in a district hospital in

Magalang, Pampanga. During his stay in the said hospital, he also had an elevated blood

pressure and he was given an antihypertensive medication which, according to him, was given

sublingually. He also uses herbal medicines like Lagundi and Oregano for cough and colds and

Paracetamol for fever.

HISTORY OF PRESENT ILLNESS

Brian Griffin mentioned that he sometimes experiences dizziness when he assumes a

standing position after a prolonged period of rest. He also visits the health center for

consultation and checking of blood pressure.

ACTIVITIES OF DAILY LIVING

Brian Griffin usually wakes up at 6:00 in the morning to prepare for work. Before leaving

for work, his morning routine usually includes eating breakfast and bathing. His work starts from

8:00 in the morning and he eats lunch at home at around 11:30 a.m. After lunch, he goes back

to work by 1:00 p.m. At around 5:00 p.m, he leaves his work to eat dinner at home, then goes

back to work again by 7:00 p.m. His work ends at 12 midnight. He usually sleeps immediately

after work. He works from Monday to Saturday. During his free day ( Sunday ), he plays with his

children and helps his wife with other household chores. A television set also serves as a form

of leisure for Brian and his family.

PHYSICAL ASSESSMENT (Final )

( March 4, 2009, Wednesday )

Vital signs:

T- 36.7 °C

P- 67 bpm

R- 18 cpm

BP- 110/70 mmHg


During the assessment, Brian Griffin was wearing a white long-sleeved shirt, black pants

and a pair of black leather shoes. He is cooperative, coherent and oriented to person, place and

time. He has a steady gait and shows no difficulty in speaking. He also exhibits thought

association and has a sense of reality. He has no difficulty recalling past and present events. He

looked exhausted. He stands 168 cm and weighs 63 kg.

HEAD AND FACE

Head

His hair is black in color. It is evenly distributed and no presence of dandruff was noted.

No presence of infestations were noted.

Skull and Face




Eyes






Ears



presence of impacted cerumen . He can hear and respond when he is asked.

Nose




Lips and Teeth


mucosa are uniform in color. He has a complete set of teeth and his tongue is in central position

and he can move it freely.

NECK

Neck Muscle



Lymph Nodes


palpation.

THORAX AND LUNGS

Lungs



Heart


Abdomen


bowel sounds.

Skin

He has brown-colored skin which is generally uniform except in areas of lighter



pinched.

Extremities


extremities.

Fingernails

His nail plates are colorless and have concave curves. They are still slightly long and

untrimmed. His nail beds returned to previous state in less than three seconds after pressure

was applied.

2. Lois Griffin

PHYSICAL ASSESSMENT


Vital signs:

T- 36.5 °C

P- 75 bpm

R- 17 cpm

BP- 110/80 mmHg


During the assessment, Lois Griffin was wearing a white shirt and pink pants. Her hair is

tied up, She is cooperative, coherent and oriented to person, place and time. She has a steady

gait and shows no difficulty in speaking. She also exhibits thought association and has a sense

of reality. She has no difficulty recalling past and present events. She stands 155 cm and

weighs 52 kg.

HEAD AND FACE

Head

Her hair is black in color. It is evenly distributed and presence of dandruff was noted. No

presence of infestations was noted.

Skull and Face

She has normocephalic skull and with smooth skull contour. No nodules and masses

were noted upon palpation. Her face is symmetrical in shape and there is no abnormal elevation


Eyes

Her eyebrows are symmetrically aligned with hair evenly distributed. Eyelashes are also


of eyelids. Lids close symmetrically. She has moist mucous membranes and her palpebral

conjunctiva is pink in color. Her pupils constrict when looking at near objects while they dilate


Ears

Her auricles are same as facial color and it is aligned with the outer canthus of the eye.


presence of impacted cerumen. Her hearing in her right ear is slightly impaired but she was able

to respond when asked.

Nose

Her nose is straight and her septum is located in the midline. No deviations have been



Lips and Teeth

Outer lips are symmetrical. She exhibits ability to move her lips. Inner lips and buccal

mucosa are uniform in color. She has an incomplete set of teeth and her tongue is in central

position and she can move it freely.

NECK

Neck Muscle


Head movements are coordinated and she can move his head freely.

Lymph Nodes


palpation.

THORAX AND LUNGS

Lungs



Heart


Abdomen

No distention and presence of lesions and masses were observed. She has normoactive

bowel sounds.

Skin

She has light brown-colored skin which is generally uniform except in areas of lighter


She has good skin turgor, which turned back to previous state in less than 3 seconds when

pinched.

Extremities


extremities.

Fingernails

Her nail plates are colorless and have concave curves. They are long and untrimmed.

Her nail beds returned to previous state in less than three seconds after pressure was applied.

NUTRITIONAL STATUS

Age: 45 years old

Height: 155 cm

Weight: 52 kg

Formula:

Body Mass Index (BMI) = Weight in kilograms (kg) Height in meter squared (m2)

Body Mass Index (BMI) = 52 kg 2.4 m2

= 21.6Interpretation:

Healthy Weight

Legend:

BMI Table ( Based on Asia-Pacific Obesity Guidelines )

Underweight < 18.5

Healthy Weight 18.6-22.9

Overweight > 23.0

At risk 23.0-24.9

Obese I 25.0-29.9

Obese II > 30.0

OBSTETRICAL HISTORY

Lois Griffin has two children . She delivered them both via Normal Spontaneous

Delivery. She delivered her first child at a secondary level hospital in Angeles City while her

second child was delivered by a midwife ( home delivery ). Her first child didn’t reach full term

and she had eclampsia during the delivery of her first child. She was also given antihypertensive

drugs which were taken sublingually for elevated blood pressure. Her second child reached full

term. She has been pregnant and has given birth two times- G2P2 ( T1P1A0L2 ).


According to Lois Griffin, she had Chickenpox and sore eyes during childhood. No

interventions were made to manage these. For episodes of fever, she took Paracetamol. She

also had eclampsia during the delivery of her first child and she was given antihypertensive

drugs for elevated blood pressure which were taken sublingually.


According to Lois Griffin, she has difficulty hearing, especially with the use of her right

ear. No intervention has been done to manage this. She also uses Lagundi and Oregano for

cough and colds and a topical for muscle pains.


Lois Griffin usually wakes up at 5:00 in the morning to prepare breakfast. After that, she

boils water for their daily drinking water. At around 8:00 a.m, she starts to do the laundry. After

doing the laundry, she performs/ does their household chores. When she’s done with the

household chores, she takes care of her children. She usually cooks lunch at around 11:00 a.m

but sometimes she doesn’t cook lunch anymore, since Brian brings home lunch. She looks after

her children for the rest of the day and sometimes she looks after her neighbors’ children. She

eats dinner at around 6:00 p.m or by the time Brian arrives from work. She usually sleeps by

10:00 p.m. A television set serves as a form of leisure and she also plays with her children.

PHYSICAL ASSESSMENT ( Final )


Vital signs:

T- 36.8 °C

P- 78 bpm

R- 20 cpm

BP- 110/70 mmHg


During the assessment, Lois Griffin was wearing a yellow blouse and brown pants. Her

hair is tied up, She is cooperative, coherent and oriented to person, place and time. She has a

steady gait and shows no difficulty in speaking. She also exhibits thought association and has a

sense of reality. She has no difficulty recalling past and present events. She stands 155 cm and

weighs 52 kg.

HEAD AND FACE

Head

Her hair is black in color. It is evenly distributed and presence of dandruff was noted. No

presence of infestations were noted.

Skull and Face




Eyes






Ears



presence of impacted cerumen . Her hearing in her right ear is slightly impaired but she was

able to respond when asked.

Nose




Lips and Teeth




NECK

Neck Muscle



Lymph Nodes


palpation.

THORAX AND LUNGS

Lungs



Heart


Abdomen


bowel sounds.

Skin

She has light brown-colored skin which is generally uniform except in areas of lighter



pinched.

Extremities


extremities.

Fingernails

Her nail plates are colorless and have concave curves. They are long and untrimmed.

Her nail beds returned to previous state in less than three seconds after pressure was applied.

3.Meg Griffin

PHYSICAL ASSESSMENT


Vital signs:

T- 36.3 °C

P- 89 bpm

R- 22 cpm


During the assessment, Lois Griffin was wearing a white shirt and green pants. She is

unable to express herself through speech. She has a steady gait and unkempt appearance. She

stands 88 cm and weighs 9 kg.

HEAD AND FACE

Head

Her hair is slightly dark brown to black in color. It is evenly distributed and no presence

of dandruff was noted. No presence of infestations were noted.

Skull and Face




Eyes


evenly distributed. Skin is intact, with discharges in minimal amount and no discolorations are

present at the surface of eyelids. Lids close symmetrically. She has moist mucous membranes

and her palpebral conjunctiva is pink in color. Her pupils constrict when looking at near objects

while they dilate when looking at far objects.

Ears



presence of impacted cerumen . She can hear and respond only through movements.

Nose


observed in the shape, size and color of the external nose. Discharges in minimal amount were

noted and there is the absence of nasal flaring. Also, no nodules and masses were noted upon

palpation.

Lips and Teeth




NECK

Neck Muscle



Lymph Nodes


palpation.

THORAX AND LUNGS

Lungs



Heart


Abdomen


bowel sounds.

Skin

She has brown-colored skin which is generally uniform except in areas of lighter

pigmentation such as the palms, lips and nail beds. A small wound was found on her right knee.


pinched.

Extremities


extremities.

Fingernails

Her nail plates are colorless and have concave curves. They are slightly dirty and

untrimmed. Her nail beds returned to previous state in less than three seconds after pressure

was applied.

NUTRITIONAL STATUS

Age: 4 years old

Height: 88 cm

Weight: 9 kg

Interpretation: ( Based on FNRI )

Malnourished

GROWTH AND DEVELOPMENT

Erik Erikson’s Psychosocial Stage

Meg Griffin is considered to be under the Autonomy vs. Shame and Doubt, although her

age should be under the Initiative vs. Guilt stage. Meg can’t express herself through speech.

Also, according to Lois, her mother, she is having temper tantrums and exhibits separation

anxiety. She also cries loudly and demandingly and sometimes rejects any attempts to be

comforted.

Sigmund Freud’s Psychosexual Stage

Meg Griffin is considered to be under the Anal phase. She says the word “ihi” to tell her

mother that she needs to void. She is learning to control urination and defecation.


According to Meg’s mother, Lois, Meg had erratic parasitism a few weeks before the

assessment. No intervention was done to manage this. Meg has no history of hospitalization or

any other serious childhood illness.


Most often, Meg acquires cough and colds and the family manages this through a herbal

medicine, Lagundi. Nasal discharges were noted on the assessment.


Meg usually wakes up at 7:00 a.m. She eats breakfast first, then she plays or watches

television with her brother. She takes a nap usually around 9:30 or 10:00 a.m and wakes up by

11:00 or 11:30 a.m to eat lunch. She does most of her leisure activities in the afternoon like

playing with their neighbors and sometimes she also takes afternoon naps. She eats dinner at

around 6:30 p.m or by the time her father arrives sform work. She usually sleeps at around 9:00

or 10:00 p.m.



Vital signs:

T- 36.5 °C

P- 85 bpm

R- 24 cpm


During the assessment, Lois Griffin was wearing a long white dress. She is unable to

express herself through speech. She has a steady gait and unkempt appearance. She stands

88 cm and weighs 9 kg.

HEAD AND FACE

Head

Her hair is slightly dark brown to black in color. It is evenly distributed and no presence

of dandruff was noted. No presence of infestations were noted.

Skull and Face




Eyes


evenly distributed. Skin is intact, with no discharges and no discolorations present at the surface




Ears



presence of impacted cerumen . She can hear and respond only through movements.

Nose


observed in the shape, size and color of the external nose. No discharges were noted and

there is the absence of nasal flaring. Also, no nodules and masses were noted upon palpation.

Lips and Teeth




NECK

Neck Muscle



Lymph Nodes


palpation.

THORAX AND LUNGS

Lungs



Heart


Abdomen


bowel sounds.

Skin

She has brown-colored skin which is generally uniform except in areas of lighter

pigmentation such as the palms, lips and nail beds. A small wound was found on her right knee.


pinched.

Extremities


extremities.

Fingernails

Her nail plates are colorless and have concave curves. They are trimmed and short. Her

nail beds returned to previous state in less than three seconds after pressure was applied.

4. Stewie Griffin

PHYSICAL ASSESSMENT


Vital signs:

T- 36.2 °C

P- 90 bpm

R- 20 cpm


During the assessment, Stewie was wearing a white shirt and red shorts, and a pair of

blue slippers. He is unable to express himself through speech. He has a steady gait. He stands


HEAD AND FACE

Head

His hair is dark brown in color. It is evenly distributed and no presence of dandruff was

noted. No presence of infestations were noted.

Skull and Face




Eyes






Ears



presence of impacted cerumen . A small wound was found at the lower pinna of his left ear. He

can hear and respond through head movements.

Nose




Lips and Teeth


mucosa are uniform in color. He has an incomplete set of teeth and his tongue is in central

position and he can move it freely.

NECK

Neck Muscle



Lymph Nodes


palpation.

THORAX AND LUNGS

Lungs



Heart


Abdomen


bowel sounds.

Skin

He has light brown-colored skin which is generally uniform except in areas of lighter



pinched.

Extremities


extremities. Wounds are present on both lower extremities and right hand.

Fingernails

His nail plates are colorless and have concave curves. They are dirty and untrimmed.

His nail beds returned to previous state in less than three seconds after pressure was applied.

NUTRITIONAL STATUS

Age: 3 years old

Height: 88 cm

Weight: 10 kg

Interpretation: ( Based on FNRI )

Malnourished

GROWTH AND DEVELOPMENT

Erik Erikson’s Psychosocial Stage

Stewie is considered to be under the Autonomy vs. Shame and Doubt stage. He likes to

be carried by his mother and also has temper tantrums. According to Lois, his mother, he is just

silent and has less facial expressions.

Sigmund Freud’s Psychosexual Stage

Stewie is considered to be under the Anal phase. He is able to go to the bathroom when

he needs to void and defecate but still needs assistance from his mother or father.


According to Lois, Stewie did not have any history of childhood illness except for fever.

This was managed through tepid sponge bath.


Stewie Griffin has no history of present illness. Only intermittent episodes of cough and

colds are experienced by the patient. This were managed through the use of Lagundi and water

therapy.


Stewie usually wakes up by the time his mother wakes up, and that is at around 5:00

a.m. He eats his breakfast at around 7:00 a.m and takes his nap at around 9:30 or 10:00 a.m up

to 11:00 or 11:30 a.m. At around 11:30 a.m or 12:00 noon, he takes his lunch. He usually

spends his afternoon doing leisure activities such as watching tv and playing with their

neighbors, and sometimes, he also takes afternoon naps. He eats dinner at around 6:30 p.m or

by the time his father arrives from work. He usually sleeps at around 9:00 or 10:00 p.m.



Vital signs:

T- 36 °C

P- 81 bpm

R- 20 cpm


During the assessment, Stewie was wearing a white shirt and green shorts, and a pair of

blue slippers. He is unable to express himself through speech. He has a steady gait. He stands


HEAD AND FACE

Head

His hair is dark brown in color. It is evenly distributed and no presence of dandruff was

noted. No presence of infestations were noted.

Skull and Face




Eyes






Ears



presence of impacted cerumen . He can hear and respond through head movements.

Nose




Lips and Teeth


mucosa are uniform in color. He has an incomplete set of teeth and his tongue is in central

position and he can move it freely.

NECK

Neck Muscle



Lymph Nodes


palpation.

THORAX AND LUNGS

Lungs



Heart


Abdomen


bowel sounds.

Skin

He has light brown-colored skin which is generally uniform except in areas of lighter



pinched.

Extremities


extremities. Wounds are present on both lower extremities and right hand.

Fingernails

His nail plates are colorless and have concave curves. They are dirty and untrimmed.

His nail beds returned to previous state in less than three seconds after pressure was applied.

IV. SOCIO-ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT

A. Type of Family Structure

The Griffin Family is a nuclear type of family, composed of parents: Brian and Lois, and

children: 4-year old Meg, and 3-year old Stewie. Brian and Lois are married for 5 years now.

Although the family is not lucky enough to have a wealthy and comfortable living, they still

manage to surpass every challenging situation that they encounter by having a positive outlook

in life.

B. Dominant family members in terms of decision making especially to health care

In terms of decision making, whether heath care-related or not, it is Brian Griffin who

usually do it, although he still considers the suggestions and preferences of Lois, his wife.

C. Source of Income, Expenditures

The family’s source of income is Brian Griffin’s wage from being a construction worker,

earning Php275/day or Php8250/month. That would denote each member of the household

spends Php2062.50 monthly. According to NEDA, a family with an average income of less than

P 2768.60 per individual per month is considered poor. Ergo, one can classify the Griffin family

as poor. The family admits that the total earnings do not always suffice for their basic needs

such as food, clothing, extra expenses, electricity and water bill. Summary of their estimated

monthly expenses is as follows:

EXPENSES AMOUNT

Food Php6000

Clothing and other expenses 2000

Electricity 200

Water 250

Total: Php8450

According to Griffin family, in case of emergency in medical-related needs, they do not

have anyone to ask for help. They just hope that perhaps, a kind neighbor or two will be willing

to lend them some money.

D. Working Hours

Brian Griffin is the breadwinner of the household. He works from 6 am to 10 pm, 16

hours a day, Mondays to Saturdays. He is given a lunch and a dinner break, where he goes

home to eat around 12-1pm and 6-7pm, respectively.

E. Ethnic background and Religious Affiliation

Brian is a Kapampamangan native, whilst Lois is an Illongga woman. The family’s

religion is Roman Catholic, so very few restrictions are being implemented, almost negligible.

According to Lois, they attend the Holy Mass during Sundays.

F. Significant other’s roles in the family Life

Basically, the significant others’ roles in the family life is almost negligible. Lois’s

relatives are also struggling for food in the province of Negros, whilst Brian’s family of

orientation has already died. Ergo, there is really no one to help them in times of crises. Their

only hope is basically, each other.

G. Health habits/ Health Beliefs

The assessment of the health beliefs of the family would help student nurses to

recognize the family’s method on how they handle health problems. The family resorts to herbal

medicines due to shortage of money. Some of these would include oregano and lagundi for

colds, pounded guava leaves for diarrhea and they also take into consideration the practice of

the herbolarios specifically the manghihilots and mananawas. They also pay a visit or two at the

barangay health center for consultation in case of fever or other minor health complaints. Self-

medication with paracetamol and NSAIDS is also a practice. These health beliefs and customs

are considered factors that may greatly affect the children’s upbringing and health status.

H. Family’s involvement in Community activities

According to Lois, she often participates in seminars being held in the barangay health

center. They also make use of its services in times of minor health complaints.

I. Family’s utilization of Community Resources

Community resources in the barangay include the health center, and the chapel.. The

family makes use of the health center for the vaccination of their children and goes there in

cases of fever, coughs and cold, which can’t be managed by self-medication. Nobody in the

family goes to school as of the moment. The church is also utilized by the family as they

conscientiously attend the Holy Mass every Sunday.

J. Housing Condition

The Griffin family lives in a one-bedroom semi-concrete shack. Sheets of boards from

Brian’s previous employer were topped against each other to form the walls of the humble

bungalow. In the front yard, one can see a table where dining takes place. Plants and flowers

stand on the right corner. For protection, they lined their lot with a simple dark blue picket fence.

The receiving area for guests is the front porch. The bedroom has the largest area in the house

with wooden bed and a television for entertainment purposes. Immediately on the left is the

kitchen devoid of cooking facilities as Lois cooks occasionally using charcoal outside the house.

In there, one can find plates and utensils for cooking and eating. The toilet facility is at the back

of the house.

According to the National Building Code of the Philippines (2000) the minimum size of

room required for human habituation individually is 3.5 square meters (adult) and 1.5 square

meters (child). For information regarding the adequacy of living space, the student nurses

measured each room’s total fixtures area and subtracted it from total floor area. Afterwards, the

available living space (resulting value) is less 3 square meters (1.5 sqm each) because of Meg

and Stewie, the children in the family. Then, the remaining space will be divided among the 2

adults in the family.

The total available space is 16.92 sq m, which is minus 3 square meters as required by

Meg and Stewie. The resulting value is 13.92 which is further divided by the 2 adults in family

who are Brian and Lois, comprising of 6.96 sqm per adult family member. Ergo, the family has

adequate living space.

As for adequacy of ventilation, the total window area should be at least 10% of the total

floor area. The house has only one window, measuring only 0.27 sqm. The total floor area is

16.92. This measurement didn’t make it to the 10%. This goes to show that the house is under

poor ventilation.

For the lighting conditions, the family use incandescent bulbs as their source of light

during evenings. However, inadequacy in daytime lighting is very evident, as there is only one

window and the walls of their house are not painted, adding to the dark feel of the atmosphere.

Sleeping arrangements constitute of the one bedroom they all sleep in. Brian and Stewie

sleep on a mat on the floor, whilst Lois and Meg occupy the bed they have. Both of which are

quite hard on the back as there is no mattress available.

The family is aware of the presence of vermin like cockroaches. Buzzing mosquitoes at

night are also of a common occurrence.

Last month, their front porch was burned because of the cooking facility left unattended.

Such would then be a big fire hazard as an evidence of a history of fire has occurred.

K. Food Sources, Storage and Cooking Facilities

For breakfast, lunch and dinner, the family always buy home-cooked meals from the

canteen where Brian Griffin works. They also buy from sari-sari stores and the market near their

place. Lois only prepares the rice, and the viands will be taken cared of Brian. Food storage

comprises of food in covered casseroles or plates. Since they do not have refrigerator to keep

their leftovers, they just eat it up on the next meal. Usually, they just use homemade charcoal

stove or grill with wood to cook their rice in the front yard.

L. Water Supply (source, ownership, potability, storage)

The family has a level 3 water system. They own such water supply facility. Adults in the

family drink the water from the household tap, whilst the water to be drank by the children

should be boiled first. Their type of drinking water storage is pitchers or jars with cover.

M. Toilet Facility (type, ownership, sanitary condition)

Their toilet facility is at the rear of the house. Its nature is of a septic tank without water

carriage so naturally, it has to be mechanically flushed by pouring water in it. It is observed to be

in good condition because of the surrounding area of the toilet bowl is clean and no

discoloration or foul odor is evident.

N. Drainage System (type, sanitary, condition) and Garbage Disposal

Their drainage system is located on the other side of the road. Its type is of open and

flowing nature. The garbage disposal container is sack and it is covered. Garbage collectors get

their household garbage twice a week.

O. Social and Health Facilities Available

The community where the family resides has various social and health facilities. They

have the chapel wherein masses are celebrated; the elementary school and day care center

wherein most of the children in the barangay study; they have basketball court wherein certain

activities such as sports fest are being carried out; and the Barangay Sapalibutad Health Center

which offers an array of services such as immunization, family planning programs, perinatal

care and the like.

Carinderias, bakeries, and sari-sari stores are also found in the vicinity of the

community.

P. Communication and Transportation Facilities

In the community, the families who can afford have telephone lines installed and own

their own transportation vehicle. However, the Griffin family can’t, so they just have to deal with

commuting, riding a bicycle, a tricycle or public utility jeepney to go places. They can also walk if

the destination is just considerably near. Their primary means of communication is the actual

familial interaction. Their family seemed closed-knit anyway they communicate with their family

in Negros through their neighbor’s cellphone.

V. PROBLEM IDENTIFICATION

A. List of Problem Identified

No. Problems Identified Score Rank

1 Presence of Health Deficit: Cough and Colds 4.67 1

2Poor Environmental Sanitation: Presence of Vermin, Rodents

and Flies4.34 2

3 Presence of Health Deficit: Parasitism 4.17 3

4 Poor Personal Hygiene 3.84 4

5Family size beyond what family resources can adequately

provide: Inadequate Family Resources3.34 5

6 Presence of Accident Hazard: Fire Hazard 3 6

7 Poor Environmental Sanitation: Lack of Food Storage Facilities 2.84 7.5

8 Poor Daytime Lighting Condition 2.84 7.5

9 Presence of Developmental Delay 2.33 9

10 Poor Ventilation due to Economic/ Cost Implication 1 10

B. Priority Setting

Problem# 1: Presence of Health Deficit: Cough and Colds

Criteria ComputationActual score

Justification

1. Nature of the problem

3/3 x 1 1

The problem is a health deficit, cough and colds are deemed to be a normal reaction of the body against microorganism which has invaded the body, and this is by expelling these microorganisms through coughing reflex.

2.Modifiability of the problem

Current knowledge

Family Resources

SN Resources

Community Resources

2/2 x 2 2 Upon the observation of the criteria regarding the modifiability aspect of the problem, the student nurses was able to deem that that the problem has a highly modifiable aspect AEB the justifications stated below:

> The family has a current knowledge of the problem as during the interview the Mrs. Lois was able to verbalize the presence of the problem "inuubo tsaka sinisipon sila"(they have cough and colds)

> The family's manpower and physical resources are available AEB the family's willingness to cooperate and comply with the Student Nurses health teachings and as verbalized by Mrs. Lois she has a management for the problem AEB her statement: “kapag inuubo sila, gumagamit ako nung lagundi, minsan yung oregano pag walng lagundi” (when they have cough and colds, I tend to give them lagundi extracts and if not I use oregano as alternative)

> The Student Nurses are well informed and knowledgeable about the mechanism of cough reflex and the management to be done to prevent the occurrence of complications thus making them enable to impart this knowledge to the family, another thing is the Student Nurses willingness to help the family to minimize if not to eradicate this problem.

> The Barangay Health Center offers Mother's Class and conducts information

dissemination on how to properly manage such problem and when to seek medical attention.

3. Preventive Potential

Severity ▼

Duration ▲

Current Management

▲

High -risk Group

▲

2/3 x 1 .67

Prevention of aggravating these conditions have a moderate potentiality as reflected by the criteria the Student Nurses have observed:

> The problem is already severe as both of the children are affected.

>The problem has existed for not so long time ago, since this problem just existed 2-3 days ago therefore this can still be managed through home care.

>The family has a current management on the problem, “kapag inuubo sila, gumagamit ako nung lagundi, minsan yung oregano pag walng lagundi” (when they have cough and colds, I tend to give them lagundi extracts and if not I use oregano as alternative) as verbalized by Mrs. Lois upon interview.

> The children are the high risk group of the problem, since their not well develop immune system and their lifestyle as a child makes them susceptible in acquiring such conditions.

4. Salience of the problem

2/2 x 1 1

Prior to the interventions and health teachings, the family has already viewed this as a problem, which needs an immediate action.

Total Score 4.67

Problem# 2 Poor Environmental Sanitation: Presence of Vermin, Rodents and Flies


Justification


2/3 x 1 .67

Presence vermin, rodents, flies and mosquitoes are good vector of diseases; presence of these vectors increases the susceptibility of acquiring diseases, thus imposing a health threat to the Griffin Family.

2.Modifiability of the 2/2 x 2 2 The problem is highly modifiable AEB the

following criteria observed:

problem

Current knowledge

Family Resources

SN Resources

Community Resources

> The family has a current knowledge of the problem as during the interview the Mrs. Lois was able to verbalize the presence of the problem "ay oo may mga daga dito tsaka ipis ganyan"(oh yes there are rats and cockroach here)

> The family's manpower and physical resources are available AEB the family's willingness to cooperate and comply with the Student Nurses health teachings and as verbalized by Mrs. Lois they minimize presence of such mosquitoes by physical means.

> The Student Nurses are well informed and knowledgeable about vector borne diseases and the management to be done to prevent the occurrence of these diseases and on how to eradicate those rodents and insects, thus making them enable to impart these knowledge to the family, another thing is the Student Nurses willingness to help the family to minimize if not to eradicate this problem.

> The Barangay Health Center offers Mother's Class and conducts information dissemination on how to prevent the multiplication of these vectors and insecticides are also available in the community.


Severity ▲

Duration ▼

Current Management

▲

High -risk Group ▲

2/3 x 1 .67 Prevention of these vectors has a moderate potentiality as reflected by the criteria the Student Nurses have observed:

> The problem is not yet severe since no one on the family was affected by the problem, the rodents bit no one, no one has acquired any of the vector borne diseases.

>The problem has existed for a long time ago, this has already existed approximately for almost 5 years as verbalized by Mrs. Lois that there were already rodents and insects the moment they transferred to their house

>The family has a current management on the problem this is through physical means,

"pinapatay namin yung lamok sa kamay" (we kill them by clapping our hands against them) as verbalized by Mrs. Lois upon interview.

> The children and even Mr. Mrs. Griffin are all at risk to be affected of the problem, since they all live on the house.


2/2 x 1 1

Prior to the interventions and health teachings, the family has already viewed this as a problem, which needs an immediate action.

Total Score 4.34

Problem# 3 Presence of Health Deficit: Parasitism


Justification


3/3 x 1 1

Parasitism are health deficits brought about by poor personal hygiene wherein helminthes invade a child’s body more particular of the gastrointestinal tract, thus, leading to infection and poor nutritional status.


Current knowledge

Family Resources

SN Resources

Community Resources

2/2 x 2 2 As reflected by the criteria below, it shows that the problem on presence of parasitism has a high modifiability status.

> Mrs. Lois Griffin is fully aware of the problem as she has mentioned the following statement during the interview: “si meg nung kamakailan lang nagsuka ng bulate”(meg vomited a worm just recently)

> The family has manpower resources that enable them to easily bring their children to the barangay health center for proper management.

> With the student nurses knowledge and childhood illness background the student nurses can provide the family health teachings about the importance of preventing this condition to promote good nutritional status

> The barangay health center provides free dewormer that would manage the family

problem regarding parasitism. 3. Preventive

Potential

Severity ▲

Duration ▼

Current Management

▼


2/3 x 1 .67

The problem of the Griffin family regarding parasitism has a moderate preventive potential after the student nurses has considered the following criteria presented below.

> The problem is not that severe as meg is the only one affected by the said condition.

> The problem approximately exists long ago as Meg was already able to manifest erratic parasitism.

> The family does not manage the problem as Lois is afraid of giving dewormer to Meg due to misinterpretation of the said intervention AEB by her statement: “yung kapitbahay kasi naming nung pinurga nya yung anak nya namatay kasi lumabas sa bibig yung bulate, kaya natatakot ako purgahin si Meg”(I am afraid to deworm Meg as when my neighbor dewormed her child, her child died because the worms came out on his mouth)

> Meg is the primary high risk group of the said problem.


1/2 x 1 .5

Prior to the student nurses verbalizing the problem to the family, the family is already aware of this but for them it does not need an immediate action.

Total Score 4.17

Problem# 4 Poor Personal Hygiene


Justification


2/3 x 1 .67

Poor Personal hygiene is a health threat to the family as this problem predisposes to health deficits such as parasitism, cough and colds and other hygiene – related health deficit.

2/2 x 2 2 Upon the observation of the criteria


Current knowledge

Family Resources

SN Resources

Community Resources

regarding the modifiability aspect of the problem, the student nurses was able to deem that that the problem has a highly modifiable aspect AEB the justifications stated below:

>Lois is fully aware of the said problem especially to her children.

> The family has physical resources specifically cleaning articles such as soap, shampoo and the like.

> The student nurses knowledge will enable them to provide the family with health teachings regarding personal hygiene such as cutting their finger and toenails, washing their hands and the like.

>The community offers Mother’s Class where the family could learn about good personal hygiene.


Severity ▼

Duration ▼

Current Management

▲

High -risk Group

▲

2/3 x 1 .67

After the Student nurses have analyzed the criteria on determining the Preventive Potential of the problem, it suggests that the problem has a moderate preventive potential.

> The problem is already severe as the almost of the family members are observed to have a poor personal hygiene and one of the family member already manifesting a hygiene – related illness. (Meg- parasitism)

> The problem on poor personal hygiene approximately exists for 5 months already as Mrs. Lois tries to limit all of their consumption due to limited financial resources, thus affecting the family hygiene.

> as a management the family still make sure that they take a bath for at least once a day.

>All of the family member are the high risk group of the said problem as all of them has a poor personal hygiene thus all of them are susceptible to acquire health deficit.


1/2 x 1 .5Prior to the student nurses do their interventions; the family does not see their poor personal hygiene as a problem at all.

Total Score 3.84

Problem# 5 Family size beyond what family resources can adequately provide: Inadequate Family Resources


Justification


2/3 x 1 .67

The problem is a health threat, inadequacy of the family resources to suffice their daily needs may result to serious health problems if not corrected e.g. malnutrition which is now actually evident in the family since the children are all underweight.


Current knowledge

Family Resources

SN Resources Community Resources

1/2 x 2 1 The problem is partially modifiable as reflected by the criteria being considered:

> The family has a current knowledge of the problem, as Mrs. Lois was able to verbalize this problem during the interview when the Student Nurses asked her of what are their problems in their house"...haaay syempre mahirap ang buhay ngaun kaya pera ang pinakaproblema namin” (of course with the increasing financial problem, money is our main problem) as verbalized by Mrs. Lois.

> Family's physical and manpower resources are not enough to correct the problem. Mr. Brian's income is not enough to suffice their needs.

>The Student Nurses can pinpoint some tips on how they are going to minimize their water and electric consumption and enumerate some foods that are nutritious yet cheap which may help in lowering their expenses. Examples of this are: Use fluorescent lamp instead of light

bulbs. Close the faucet when not in use Remove barriers on the windows to let

the sunlight enter the house so that they may minimize the use of electricity for lighting.

Foods such as vegetables, tofu and the like.

> Community Resources are not available, since if the community would manage the family problem, they also have to help the other families which have the said problem

and the community’s budget is not enough to respond on this problem.


Severity ▼

Duration ▲

Current Management

▲


2/3 x 1 .67

The problem has a moderate preventive potential as reflected by the following criteria:

> The family's monthly income is really small and would not suffice their needs and if to compare with the NEDA prescribed share amount of money that each of the family members must have it is really far behind. NEDA- P2, 768.60Griffin family- P8250 (P8250/4 = P2062.50/ individual)And to analyze their expenses it would show that they spend more of what they can adequately provide:

Food – P6000Miscellaneous – P2000Electricity - P200Water - P250TOTAL - P8450>The problem existed for almost 5 months ago after Brian lost his job.

> The family has a current management on the problem since Mr. Brian was able to find a job on a construction firm at the city vicinity.

> All of the family members with emphasis on the children are the risk group of the problem as they have all their basic need that must be sufficed.


2/2 x 1 1

The family sees this as a problem, which is for them, needs an immediate action AEB when the Student Nurses did their interview Mrs. Lois was able to verbalize their problem financially.

Total Score 3.34

Problem# 6 Presence of Accident Hazard: Fire Hazard


Justification


2/3 x 1 .67 Accident hazards are health threat to the family; on the griffin family’s case their faulty

wirings are fire hazards wherein if fire happens on their house brought about by this faulty wirings, fatality is mostly to occur.


Current knowledge

Family Resources


1/2 x 2 1

After the student nurses have considered the following criteria below, it reflected that the problem is moderately modifiable.

> the family has a current knowledge of the problem AEB Lois statement during the interview: “madaling magkasunog dito, nasunugan na kami nung January 30”(this house can easily be damage by fire, we have experienced it last January 30)

> The family’s financial resources will not be able to suffice the expenses needed to fix the problem, since they are already experiencing financial shortage for their daily needs.

> The student nurses could inform the family about the existence of the problem and site some possible consequences that may arise brought about by faulty wirings such as fire.

> There are no available community resources since if the community will do something about the problem they also have to do the same actions they have done to the Griffin family.


Severity ▼

Duration ▼

Current Management

▼


1/3 x 1 .33 After the student nurses have considered the following criteria below, it reflected that the problem has a low preventive potential.

> The problem is severe as observed by the student nurses as majority of the electrical wiring are exposed, and as aforementioned by Lois, they have already experience fire accident last January 30, and their neighbor experienced it too.

> The problem approximately exists for about 5 years since the problem have existed when Mrs. Lois and her family transferred to that house.“nung lumipat kami dito ganito na yung itsura ng bahay” (when we transferred here the house physical structure was already like this.)

> The family does not have any current management to the problem due to lack of financial resources.

> All of the family members are exposed to the problem, since all of them resides on that house.


2/2 x 1 1

Prior to the student nurses conduct their interventions; the family sees it as a problem which according to Lois needs an immediate attention.

Total Score 3

Problem# 7.5: Poor Environmental Sanitation: Lack of Food Storage Facilities


Justification


2/3 x 1 .67

The Griffin Family’s problem on lack of food storage facilities is considered to be a health threat as it predisposes the family to Gastrointestinal problems such as diarrhea, Acute Gastroenteritis and other food borne diseases, since improper storage of food predisposes contamination of the food thus leading to the said Gastrointestinal problems.

2.Modifiability of theproblem

1/2 x 2 1

Upon the observation of the criteria regarding the modifiability aspect of the problem, the student nurses was able to deem that that the problem has a partially modifiable aspect AEB the justifications stated below:

> the family has a current knowledge of the said problem AEB Lois statement: “tinatakpan ko na lang ng pinggan yung tira namin na pagkain kung meron, nilalangaw kasi, wala naman ako paglalagyan”(I just cover it with plates if ever we have left over foods, to prevent those flies going on to the food, we don’t have any food storage to utilize)

> The family does not have any physical resources such as articles like Tupperware that they can use to store their foods, and also the family does not have enough financial resources to suffice the expenses they need for them to b able to buy those

Current knowledge

Family Resources


storage facilities mentioned.

> With the equipped knowledge that the student nurses have, the student nurses are capable enough to provide health teachings to the family such as the consequences that may arise due to lack of food storage facilities such as contamination of the food they eat ant the ingredients they use in cooking.

> the community is not directly related to address the problem, the problem is more of a family oriented problem therefore, a family oriented action would be helpful in managing the problem.


Severity ▼

Duration ▼Current

Management ▲


2/3 x 1 .67

Upon the assessment of the following criteria mentioned below, the problem on lack of storage facilities yields a moderate preventive potential.

> The problem of the family on lack of food storage facilities is considered to be severe as evidenced by the observations of the student nurses upon the assessment of the housing and environmental sanitation of the house the student nurses was able to observe that the storage facility that the family uses is very dirty as evidenced by soil particles and flies present on the storage facility.

> The problem is already long duration since they do not really have enough utensils and storage facilities even before (5 years approximation)

> As a management to the problem Lois uses plates to cover their left over foods if any.

> High- risk group are all the family members of the Griffin family since all of them benefit on the said food.


1/2 x 1 .5The family see this as a problem but it does not need an immediate action as they have more prioritized problem compared to this.

Total Score 2.84

Problem# 7.5: Poor Daytime Lighting Condition


Justification


2/3 x 1 .67

The family’s problem on poor lighting is considered to be a health threat to the family, since with poor lighting condition, it may bring strain on the eyes which may lead to eye problem such as blurring of the vision, another thing is this may lead to accidents since without the use of enhancement for lighting condition such as lamps the family member cannot see their home environment clearly thus may lead to accidents such as sliding and the like.


Current knowledge

Family Resources


1/2 x 2 1 After considering the criteria below, the Student Nurses have arrived to a result that shows that the problem of the Griffin family is moderately modifiable.

> The family has a current knowledge on the problem as shown with the behavior of Mrs. Lois wherein the student nurses have observed Mrs. Lois invites the student nurse to just stay on the outside.“pasensya na kayo dito na lang tayo sa labas madilim kasi”(let’s stay here outside it is too dark inside).

> The family has limited financial resources in which the family cannot suffice the expenses in improving their lighting condition.

> The student nurses are well equipped of the knowledge about having a good lighting condition thus, the student nurses can provide the family some health teachings to the family regarding the importance of having a good lighting condition such as it prevent straining the eye and making their environment more visible, they can also pinpoint some articles that contribute to the problem such as the curtain that blocks the light coming in on their small window.

> The community itself has limited resources

to address this problem, as observed, most of the household on the community suffers from this problem, thus the community must respond to the problem of the other members of the community if the community will respond to the problem of the Griffin Family.


Severity ▼

Duration ▼

Current Management

▲


2/3 x 1 .67

The Griffin family’s problem on poor lighting condition has a moderate preventive potential as reflected by the criteria shown below:

> The problem is severe as evidenced by upon entering the house the student nurse have observed that it is impossible to see without the aid of electricity, the house is so dark.

>The problem has exist for approximately about almost 5 years, as stated by Mrs. Lois:“dati ang madilim dito, kahit nung paglipat pa lang namin dito” (this situation was the same even the first day we were here when we transferred, it is really dim inside the house)

>The family uses light bulbs and open their window to manage the problem.

> All of the family members of the Griffin family are exposed to this problem as they were all living on that house.


1/2 x 1 .5

Poor lighting condition is viewed by the family as a problem upon interview with Lois and does not need immediate action prior to the student nurses conduct their health teachings.

Total Score 2.84

Problem# 9: Presence of Developmental Delay


Justification


3/3 x 1 1

Developmental Delay is a health deficit as a delay in the developmental years would only indicate an abnormal physiological function of the body.


1/2 x 2 1 The problem is partially modifiable upon the consideration of the following criteria:

>The family does not have any current

Current knowledge

Family Resources


knowledge on the problem AEB Mrs. Lois just regard the problem as if it is just only normal for Meg as she is a preterm child.

> Family manpower resources are available; the family can go to the Barangay Health Center for proper referral.

> Student Nurses are well equipped with knowledge and skills enabling them to impart information about the presence of the problem so that the family could address this problem properly and avoid aggravation of the said condition.

> Community has NGO’s and government hospitals for proper medical management of the problem.


Severity ▼

Duration ▼Current

Management ▼


1/3 x 1 .33

The problem has a low preventive potential as reflected on the following criteria the Student Nurses considered:

> The problem is considered to be severe due to the following reasons:

The awareness of the family to this problem is not evident.

With Meg’s age, her actions are inappropriate AEB she still doesn’t know how to speak which is not expected for children like her with the same age.

>The problem exists for so long already approximately 3 years as she meg is already 4 years old now and the things she does is only normal for a child with 1 year of age.

>They family do not have any management on this problem since their awareness to this problem is not evident.

>The main risk group of the problem is Meg; Lois is also affected especially on doing her ADL’s since she has to attend with Meg’s needs.


0/2 x 1 0

The family does not view Meg’s developmental delay as a problem since they are not aware of the existence of this problem prior to the Student Nurses informing them about this problem.

Total Score 2.33

Problem# 10 Poor Ventilation due to Economic/ Cost Implication


Justification


2/3 x 1 .67

The problem is basically a health threat to the Griffin Family as poor ventilation condition predisposes cross contamination since there is an inadequate air circulating on their home environment, another thing is that with poor ventilation condition, the family members may suffer to respiratory problems since there is minimal amount of air circulating on their house.


Current knowledge

Family Resources

SN Resources

Community Resources

0/2 x 2 0

After the student nurses have considered the following criteria below, it reflected that the problem is highly modifiable.

> The family has no current knowledge of the said problem AEB upon interview, Mrs. Lois told the student Nurses that: “hindi naman problema yan ganyan nay an dati pa, tsaka ok lang yan presko naman napasok naman ang hangin eh”(it’s not a problem anymore, it is just the same when we transferred here, anyway it is cool here)

> The family has limited resources especially financial resources since they are currently financially challenged.

> With the skills, initiative and knowledge of the student nurses, the student nurses can provide the family with health teachings regarding the importance of having a good ventilation condition such as it will promote relaxation and prevent cross contamination of diseases.> The community has no adequate resources on resolving the problem, since it would be of too much cost on the community funds.


Severity ▼1/3 x 1 .33

After the student nurses have considered the following criteria below, it reflected that the problem has a low preventive potential.

> The measurement of the windows of the house of the Griffin Family have not passed

Duration ▼

Current Management

▼


the standard of the National Building code of the Philippines R.A 6541 as evidenced by the total measurement of the windows of the house yield 0.27m2 which is less than 1/10th

of the total floor area of the house (16.92m2), making their ventilation condition poor.

> The problem on poor ventilation condition of the Griffin Family existed for approximately almost 5 years ago, as verbalized by Mrs. Lois on her statement:“nung lumipat kami dito ganyan na yan” (when we transferred here the windows are already like that)

> The family does not have any current management of the problem due to low salience of the problem.

> All of the family members are all affected of the problem since all of them is living together on that house.


0/2 x 1 0Mrs. Lois does not regard this as a problem.

Total Score 1

VI. FAMILY NURSING CARE PLAN (in order of priority)

Problem# 1: Presence of Health Deficit: Cough and Colds

CUES FAMILY NURSING PROBLEM

OBJECTIVES INTERVENTIONS RATIONALE METHOD OF FAMILY

CONTACT

RESOURCES EVALUATION

>Presence of nasal discharges (meg an stewie)

>Verbal reports by Lois Griffin

>Inability to make decisions with respect to taking appropriate health action due to inability to decide which action to take.>Inability to provide adequate nursing care to the sick, dependent members of the family due to lack of knowledge about health condition and necessary intervention/ treatment/ care.

Short Term:>After 1-2 hrs. Factors that can contribute to its occurrence.Long Term:>After the end of the 5th home visit, the members of the family will have changes in lifestyle to prevent coughs and colds.

>Determine factors that can contribute to its occurrence.>Assess for Family’s current knowledge.>Reinforce non pharmacologic measures such as water therapy.>Identify community resources and facilities for support.>Teach deep breathing exercises and coughing exercises>Advice client to eat vit. C rich food >Prevent from drinking milk

> to determine contributing factors/ etiologies.>To obtain baseline data.

>to promote wellness

>To increase immune system>To prevent increasing mucus consolidation

Home Visit >Time and effort of the student nurses and the family

>After 1-2 hours of home visit, the members of the family shall have verbalized different ways to manage cough colds.>At the end of 5 home visits, the members of the family shall have demonstrated changes in lifestyle to prevent coughs and colds.

Problem# 2: Poor Environmental Sanitation: Presence of Vermin, Rodents and Flies

CUES FAMILY NURSING PROBLEM

OBJECTIVES INTERVENTIONS RATIONALE METHOD OF FAMILY

CONTACT

RESOURCES EVALUATION

>presence of cockroaches mostly in kitchen>absence of accessible sink in the kitchen>kitchen and storage are in dose proximity

>Inability to provide a home environment conducive to health maintenance due to inadequate family resources specifically financial constraint and limited physical resources

Short Term:>After 1hrs. Nursing intervention the family will verbalize different methods to minimize presence of vermin.Long Term>After 3 days of Nursing Intervention family will minimize and control the presence of cockroaches.

>Assess family’s environmental conditions.

>Discuss and explain importance of environmental sanitation>Discuss use of pesticides and other physical method to reduce number of pests in the house>Encourage immediate plates and kitchenware before and after use.>Encourage proper hand washing before and after eating

>To obtain baseline data for planning appropriate interventions>having a clean environment greatly reduces the chance of breeding vermin>Inhibits and kills the pests and thus lessening occurrence of vermin.

>Prevent unpleasant smell and areas of infestations.>Prevent ingestion of microorganism carried by pests.

Home Visit >Cooperation of both family members and student nurses>knowledge of student nurses>use of cleaning agents such as house bleach or Lysol>Pesticides

Short Term>After 1 hours of Nursing Intervention, family shall have verbalized of the importance of environmental sanitation.

Long TermAfter 3 days of home visits and Nursing Intervention, family shall have

Problem # 3: Presence of Health Deficit: Parasitism

CUESFAMILY

NURSING PROBLEM

OBJECTIVES INTERVENTIONS RATIONALEMETHOD OF

FAMILY CONTACT

RESOURCES REQUIRED EVALUATION

S> “Ayaw nila mag tsinelas pag naglalaro”

O>-The Children are not wearing their slippers when playing outside.

-The father and his children have untrimmed and dirty fingertips and toenails.

-improper hand washing when eating.

-Inability to ,ake decisions with respect to taking appropriate health action due to misconceptions or erroneous information

SHORT TERM:After 1-2 hours of home visit, the family will enumerate ways to prevent parasitism

LONG TERM:At the end of the 5th home visit, the family will practice measures to prevent parasitism and identify support groups in the community

- Assess for history of parasitism

-Determine factors associated to parasitism

-Discuss the importance of having good personal hygiene.

-Give health teachings regarding different practices on good personal hygiene.

-Discuss the following:

-Instruct them to frequently wash hands and trimmed fingernails & toenails.

- Perform the

-to know past medical history

-to identify contributing factors

-to provide health teachings that will let them maintain a good personal hygiene.

-to provide general comfort and clean body.

-to minimize the occurrence of cross infection and parasitism.


-to minimize the

Home visits Time & effort of the family and the student nurse.

After 1-2 hours of home visit, the members of the family shall have enumerated ways to prevent parasitism

At the end of the 5th home visit, the family members shall have practiced measures to prevent parasitism and identify support groups in the community

interventions to the client like teaching them to wear their slippers always, trimmed the nails of the children, and washing the hands of the children when eating.

-Perform usage of the fork and spoon when eating.

occurrence of cross infection and parasitism.

Problem # 4 HEALTH THREAT: UNHEALTHY LIFESTYLE HABIT: POOR PERSONAL HYGIENE

CUESFAMILY

NURSING PROBLEM

OBJECTIVES INTERVENTIONS RATIONALEMETHOD OF

FAMILY CONTACT


S> ØO>-The members are seen wearing dirty clothes

-The members of the family have long and dirty fingernails and toenails

-The members of the family has

-Inability to take appropriate health actions due to:-lack of adequate knowledge regarding proper hygiene-inadequate financial resources to avail proper hygiene practices and resources

SHORT TERM:After 2 hours of home visits, the family will verbalize understanding about the importance of good personal hygiene to their health

LONG TERM:

-Assess for signs of poor personal hygiene

-Determine factors associated with poor personal hygiene

-Discuss the importance of having good personal hygiene.

-to know health threats

-to know factors contributing to health threat

-to provide health teachings that will let them maintain a good personal

Home visit Family resources:-open to new information and involvement of nursing interventions

Student nurses resources:-Time & effort to explain proper hygiene practices and

SHORT TERM: The family shall have verbalized understanding about the importance of good personal hygiene to their health

LONG TERM:The family shall have demonstrated

dirty skin as a sign of not taking a bath

At the end of the 5th home visit, the family will demonstratemaintenance of good personal hygiene as evidenced by taking a bath daily and wearing comfortable clothing, trimmed fingernails and toenails.

-Give health teachings regarding different practices on good personal hygiene.

-Discuss the following:

-Instruct them to take a bath at least once a day.

-Instruct them to frequently wash hands and trimmed fingernails & toenails.

-Instruct tooth brushing at least twice a day.

- Perform the interventions to the client like bathe the children, trimmed the nails of the children, and brushed the teeth of the children.

hygiene.

-to provide general comfort and clean body.

-to provide a presentable look.


-to prevent formation of cavities/ plaques and to maintain a good oral hygiene and prevent bad breath.

adequate knowledge about the diseases in a poor personal hygiene

maintainance of good personal hygiene and applied health teachings given as evidenced by taking a bath everyday, and proper cleanliness in their bodies.

Problem #5: Family size beyond what family resources can adequately provide: Inadequate Family Resources

CUESANALYSIS OF

THE PROBLEM OBJECTIVESNURSING

INTERVENTIONS RATIONALEMETHOD OF

FAMILY CONTACT

RESOURCES REQUIRED

EXPECTED OUTCOME

S>

O> The group found out that the total monthly budget of the family is P8,250.00 which gives every member a monthly allowance of P2,062.50. It is not enough for the family’s everyday needs.

Inability to sustain their basic needs due to lack of family resources and failure to have a high paying job.

Short term:After 1-2 hrs of home visit, the family will be able to identify ways on how to properly budget their monthly income.

Long term:At the end of the 5th home visit, the family will be able to find ways on how to earn extra income sufficient to the needs of the family.

Establish rapport with the family members.

Compute for the family expenses and salary.

Assess the family’s sources of income.

Provide the family information on different methods of earning an extra income.

Encourage the family to engage in activities that would promote

To gain trust and cooperation of the family.

Provides comparison of data and determines deficiency in financial status.

Provides baseline data and determine other possible sources.

Provides creativity in the family and raising extra income.

To allow money for daily needs and to save extra money.

Home Visit Family resources:Understanding and cooperation of the family.

Student nurses resources:Skills, knowledge, time, effort and motivation of the students.

Short term:The members of the family shall have identified ways to properly budget their monthly income.

Long term:The members of the family shall have maintained practice measures to prevent fire hazards.

livelihood such as planting vegetables.

Explore ways on proper budgeting and possible extra sources of income.

To maximize the money earned by the parent.

Problem #6: Presence of Accident Hazard: Fire Hazard

CUESANALYSIS OF

THE PROBLEM OBJECTIVESNURSING

INTERVENTIONS RATIONALEMETHOD OF

FAMILY CONTACT

RESOURCES REQUIRED

EXPECTED OUTCOME

S> “Nasunugan kami nung Jan. 31.” As reported by Lois

O> presence of damaged improvised roof

Inability to make decisions with respect to taking appropriate health actions due to inaccessibility of appropriate resources for care specifically cost constraints or economic/ financial inaccessibility and failure to comprehend the nature/ magnitude of the problem.

Short term:After 1-2 hrs of home visit, the members of the family will enumerate measures to prevent fire hazards.

Long term:At the end of the 5th home visit, the members of the family will maintain to practice measures to prevent fire hazards.

Assess for the history of the event.

Determine factors which can contribute to the occurrence of such.

Enumerate ways to prevent fire hazards:

Establishment of safe cooking facilities.

Objects which can contribute to its occurrence should be properly stored.

To obtain baseline data.

To determine contributing factors.

To prevent occurrence of fire hazards.

Home Visit Time and effort of the student nurses and the family.

Short term:The members of the family shall have enumerated measures to prevent fire hazards.

Long term:The members of the family shall have maintained practice measures to prevent fire hazards.

Careful utilization of objects/ equipment that can cause fire hazards.

Problem #7.5 Poor Environmental Sanitation: Lack of Food Storage Facilities

CuesProblem Analysis Objectives Nursing

Interventions Rationale

Method of Family Contact

Resources Required

Expected Outcome

S: Ø

O:>The Family has no refrigerator>They don’t have cabinet for food

Inability to recognize the presence of the problem due to:

>Inadequate knowledge about the consequence of

Short term: After 2 hours of nursing intervention the family will verbalize understanding on the importance of proper storage of

>Establish raport

>Assess Food Storage Facilities

>Discuss to the family the possibilities of contaminating the food if not properly

>to gain trust

>to obtain baseline data

>to develop awareness to the family about the prevention and intervene about it

Home visits Family Resources:>plates and plastic food covers

Student nurse’s resources:

Short term: The family shall have verbalized understanding on the importance of proper storage of food

Long term:

storage> Leftover foods were left on the table in a plate with cover

the problem

>Inadequate financial resources to avail food storage facilities

food

Long term:After 1 of home visit, the family will comply with the health teaching given on proper food storage.

stored.

>Explain the possible consequences and complication they may acquire from contaminated food due to improper storage

>Encourage covering of food properly with plates or any appropriate

>to increase their awareness that this could bring about complication to their health.

>to prevent easy spoilage and contamination of the foods

>time and effort with the cooperation and participation of the family and student nurse.

The family shall have complied with the health teaching given on proper food storage..

Problem #7.5 Poor Daytime Lighting Condition

CuesProblem Analysis Objectives Nursing

Interventions Rationale

Method of Family Contact

Resources Required

Expected Outcome

S: Ø

O:>Upon entering the house it was quite dark and there was insufficient number of light bulbs

Inability to provide a home environment which is conducive to health maintenance due to inadequate family resources specifically:

Short term: After 1 hour of nursing intervention the family will verbalize understanding on the health teaching given regarding the importance of adequate lighting

>Assess lighting condition

>Allow the family to verbalize some ways to improve their source of lighting

>Identify with the plans to alleviate poor lighting

>to obtain baseline data

>to assess family’s compliance on the health teachings given

>to include the family in planning and increasing awareness

Home visits >Knowledge and communication skills of the student nurse

>Participation and acceptance of family members

Short term: The family shall have verbalized understanding on the health teaching given regarding the importance of adequate lighting

Long term:The family shall

>Use of 2 incandescent lights

>Hard to read when inside the house during daytime

>Financial constraints/ limited financial resources

>Limited physical resources(e.g. bulbs)

Long term:After 3 of home visits, the family will demonstrate implementation of the means the identified such as opening windows

>Instruct the mother to keep the door open during daytime

>Encourage mother to open the widows and remove obstruction such as curtains

>to provide enough light

>to provide enough light

>time and effort with the cooperation and participation of the family and student nurse.

have demonstrated implementation of the means the identified such as opening windows

Problem #10: Poor Ventilation due to Economic/ Cost Implication

CUESFAMILY

NURSING ANALYSIS

OBJECTIVES NURSING INTERVENTIONS RATIONALE

METHOD OF FAMILY CONTACT


S> Ø

O>the house has only one window measuring to 60cm x 45cm or 0.27m2 such measurement is less than 10% requirement posited by national building code of the Philippines as The total Floor area is 16.92 m2

> poor ventilation due to low salience of the problem>lack of adequate knowledge of the importance of proper ventilation.

SHORT TERM: After 1 hour, the family will be able to verbalize understanding about the importance of having adequate ventilation and consequences if having poor ventilation.

LONG TERM: After the 3 days of

>Discuss to the family the importance of having good ventilation

>Explain the possible consequences of having poor ventilation

>Provide health teachings about the significance of

>To analyze and realize the ideas regarding the matter

>For the family to become aware of the possible consequences

>To provide knowledge and realize the benefits

Home Visits >knowledge and communication skills of the nursing students.

>Participation and Acceptance of family members

>Time and effort of the student nurse and the family.

SHORT TERM: GOAL MET, After 1 hour, the family will verbalized understanding about the importance of having adequate ventilation and consequences if having poor ventilation.

>it is quite warm inside the house.

home visit, the family will be able to demonstrate techniques on how to improve proper ventilation.

adequate ventilation

>encourage to Remove unnecessary obstruction which are contained in the windows.

>Plan with the family in thinking on ways to improve ventilation

of having adequate ventilation

>To allow passage of air inside the house.

>Develop participation on part of the family.

LONG TERM: GOAL MET, After the 3 days of home visit, the family demonstrated techniques on how to improve proper ventilation.

VII. FAMILY COPING INDEX

CategoryInitial Final

Justification1 3 5 1 3 5

1. PHYSICAL INDEPENDENCE

This category is concerned with the ability to move about, to get out of bed, to take care of daily grooming, walking, etc. Note that it is the family competence that is measured- even though an individual is independent, if the family is able to compensate for this. The family is important-hence, if the focus of care is poor, for instance, if the mother is giving care to a handicapped child that she shared with other members of the family, the independence might be considered incomplete. The causes of independence may vary however. Lack of independence in the family may be due to actual physical incapacity, the inability of “know-how”, the willingness or fear of doing necessary tasks.

Initial:

The Family has moderate physical

independence ask evidenced by the

mother Is able to provide the family

need on basic needs such a s food

preparation nurturing of the children,

grooming and the like, but still the

mother still lack some more information

to proper render this care, because at

times the children are still important.

Final:

After the health teachings and

interventions given by the student

nurse the mother’s physical

independence increase to an efficient

level AEB she was able to maintain her

children hygiene.

2. THERAPEUTIC COMPETENCE

This category includes all the procedures or treatment prescribed for the care of illness, such as giving medications and using appliances, dressings, exercises, and relaxation and special diets.

Initial:

Initially the family has very low

therapeutic competence, as the mother

does not necessary manage the illness

of the members in the family, she lacks

information on “How to” do such

procedure, the family relies on OTC

drugs.

Final:

On the final visit, After giving all the

necessary intervention to correct them

previous believe and practices the

family was able tom increase their

therapeutic competence. This was

supported by the mother as she readily

responds to the question given by the

student nurse regarding certain

situation.

3. KNOWLEDGE ON HEALTH CONDITION

This category is concerned with the particular health condition that is the occasion for care, knowledge of the disease or disability, understanding of communicability of diseases and modes of transmission, understanding of general patterns of development of a newborn baby and the basic needs of infants for physical care and tender loving care.

Initial:

Upon assessing the family

knowledge about certain disease,

condition especially those of common

diseases. The mother was able to

responds on some of the question but

still lack of knowledge on how to

properly manage such diseases.

Final:

Upon final visits with the health

teachings given and reinforcement of

the knowledge, the family was able to

verbalize on how to manage these

disease in case it happen to occur in

their family.

4. APPLICATION OF PRINCIPLES OF GENERAL HYGIENE

This is concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members and carrying out accepted preventive measures such as immunizations, medical appraisal and safe homemaking habits in relation to storing and preparing food.

Initial:

In terms of application of principles

of general hygiene the family has an

idea on how to properly do the

procedure they also have the

knowledge on the importance of

completing the EPI program

Final:

After health teaching were given

appropriate intervention, during the

final visit the family is now

knowledgeable on properly do the

procedures, application of procedure in

general of its importance.

5. HEALTH ATTITUDES

This category is concerned with the way the family feels about health care in general, including preventive services, care of illness and public health measures.

Initial:

The family has a bright idea about

health are, only they do not know how

to improve and practice this activity

Final:

The final visits the family has able

to verbalize the health teaching render,

eg. It is important to address antibiotics

about health care must be definitely to

the health centre for clarification

6. EMOTIONAL COMPETENCE

This category has to do with the maturity and integrity with which the members of the family are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living. This involves the degree to which individuals accept the necessary disciplines imposed by one’s family and culture; the development and maintenance of individual responsibility and decision; and willingness to meet reasonable obligations, to accept adversity with fortitude, and to consider the needs of others as well as one’s own.

Initially, the student nurses observed

that the family has a high emotional

competence AEB how the family face

their problem with enthusiasm and

positive behavior no matter how

difficult the problem is in which the

family was able to maintain up to the

last visit.

7. FAMILY LIVING

This category is concerned largely with the interpersonal or group aspects of family life- how well the members of the family get along with one another, the ways in which they make decisions affecting the family as a whole, the degree to which they support one another and do things as a family, the degree of respect and affection the show for one another, the ways in which the manage the family budget, the kind of discipline that prevails.

Initially, the family was observed that

they have an excellent family living

AEB the family regards a high respect

to one another, they support one

another and do things as a family

especially when it comes to decision

making. The family was able to

maintain this up until the final visit.

8. PHYSICAL ENVIRONMENT

This category is concerned with the home and community or work environment as it affects family health. This includes the conditions for housing, presence of accident hazards, screening, plumbing, facilities of cooking and for privacy; level of community (deteriorated or modern, presence of social hazards such as bars, street gangs, delinquency, pest such as rats, etc.), availability and conditions of schools and transportation.

Initial:

Initially, the family’s physical

environment has a fair grade. This is

due to the presence of accident

hazards, level of storage facilities.

Transportation is also difficult; the

family uses the public mode of

transportation.

Final:

An improvement was observed after

the health teachings.

9. USE OF COMMUNITY FACILITIES

This category has to do with the degree to which family members know about and the wisdom with which they use available community resources for health, education, and welfare. The coping ability does not indicate the level of the need for services, but rather the degree to which they can cope when they must seek such aid.

Initial:

Initially, the family does not have

enough knowledge on what are the

available programs in the community

that they could avail, though they have

some ideas of the barangay programs.

Final:

During the final visit, after the

dissemination of the barangay

programs that they could avail

especially of that health related, the

family is now knowledgeable of this

and has developed interest on these

programs.

VIII. LEARNING DERIVED

I personally learned the importance of the family in the society, as the basic unit of the

society, it is important to maintain the health of the family. Comparing the family with the human

body, as when one part of the body is infected, later on the whole body will be affected

systemically, just like with the family and society, when a family is considered ill, later on the

society will be systemically affected.

I also learned the importance of good communicating skill. With the absence of a good

communicating skill the student nurse will not be able to establish rapport with his/ her client,

thus affecting the assessment process, making the problem identification and prioritization be

difficult, thus, altering the maximum care you may give to the family.

Assessment is the very crucial part of doing the family case analysis, with all the data

that you will gather throughout the assessment process, there you will derived the problems you

will intervene to correct this problems.

The most important thing that a student nurse must have is the initiative, time, effort, and

patience, without those things you will not be able to gather all the information you need, the

client’s cooperation and compliance is also a vital ingredients for the success of making a family

case analysis.

Carl Elexer Ano

At first, it was again, quite difficult for me to adjust from hospital environment to community

setting. After 2 consecutive rotations in the ward, all I could ever think of was doing SOAPIEs

and charting, making endless nursing care plans, administering meds- you get the idea.

However, in making Family Case Analysis, I realized that I could be of more help if I would focus

more on the family rather than the individual or the community as a whole, as this fundamental

unit making up the society is a buffer between the latter two, giving rise to a more efficient

catalyst I hope to become, even in just my small ways.

Finding a family was hard, and the intolerable heat was unnerving, and didn’t help at all. It was

quite of a feeling of hopelessness and lose that we weren’t able to find a family on the first day,

or let me rephrase that, “a SUITABLE family…” The first foster family we had was so depressed

that we ourselves weren’t sure if we could help them. The mother wasn’t also much of a reliable

source of information for she must have mental problems based on her words and actions. Our

second foster family- the Griffin family, was really nice and accommodating. They were an

inspiration to us, especially Mother Lois. She always has this hopeful note in her words that

everything will be all right when the time comes, and despite the fact they are poor, that wouldn’t

hinder her to always wear a smile and face the world with happiness and courage.

In making the FCA for the second time, it was a real reinforcement of establishing rapport with

the family as we have to visit them for two weeks. Perhaps, it was hard for them to treat us like

we weren’t a bother at all; as of course, people always have better things to do. Still, I’ve

learned the value of kindness and optimism through them, beyond physical examinations,

problem identification and priority setting. However trite this may sound, I can say that

somehow, God has made the family an instrument so I will bear in mind the fact that some

families have real problems, and I was chosen to try to do something about them.

Ariane Camille M. Calma

In Sapalibutad you can learn many things if you put yourself into it”. The lesson that I have

learned in the community and to our adopted family because through them I came to realize that

simple things could be a meaningful one. At first, I was wondering how to adjust myself to

different situations that I will be going to experience. But moreover, I was able to appreciate

more things because of these experiences. I learned to value those, which are essential, and

the family had taught me that the value of simplicity of life does not hinder a person to maintain

happiness and always can smile through life passes.

Requelito A. Dizon Jr

Family Case Analysis is not just about accomplishing the paper but it involves more of

indulging or integrating yourself into the life of the family you adopted so that you personally

discover problems which will allow you to do your nursing role.

The student nurses have learned that a Family Case Analysis entails hard work.

Thorough assessment is truly important to identify the problems of the family with appropriate

nursing interventions.

Through the student nurses’ exposure to various families, they also learned that

community health nurses, are the key persons in the provision of comprehensive and

continuous family health care. Thus, a genuine concern and proper coordination is needed for

the efficacious delivery of care.

Michelle Louie Sotto

“There is no higher Religion than human service to work for the common good is the

greatest creed” –George Shinn

Community Health Nursing has made me recognized the importance of nurses

and health care providers especially in rendering health to the public. Indeed I felt so

very importance to the family. I also had experienced living in the resettlement areas in

which they have to live in the narrow alley. I never knew how lucky I was not until I

experienced it. I also felt the warmth with the family worked with us so that they would

be able to sustain and maintain wellness. I believe that in order for all the people to

reach the top we have to work hand in hand. It was good to see how much we change

and impact their lives. Indeed helping other people is never been a vain.

Noel Leoncio Q. Balilo

The family is a social group, is universal and it is significant element in man’s social life.

In every part of the world it consists of family. This family case analysis has given us another

new experience. It given us a chance not only to learn and to put into practice all the things that

we learn from school but it has also provided us an opportunity to help people who are really in

need. This is a activity which will make you realize many reality in our life. It made me

understand how lucky I am with the family I have, a family which is so perfect for me to say.

After being immerse in this kind of activity, there are many thing that I have learned

about life. Upon on what we have witness on the family that we had encountered. Life is not that

easy. You must make some effort in order to survive. It’s not the material things, the fame,

fortune and power that makes us completely happy, but the thought of having helped someone

who is in great need of us. We honestly haven’t been happier that we are right now, because of

the pleasure we have knowing that we have helped people in our own little way.

Kristina Edna C. Cabrera

Through family case analysis, the student nurses learned how to develop communication skills

and how to deal with every individual in the proper way. Moreover, with the family’s economic

condition, the student nurse learned that being poor is not a hindrance to achieve and build

relationships and a healthy and satisfying life.

Doing a Family Case Analysis proved that theories are not enough to have the courage

to face all the trials in life. Basically, it was an experience that served as an eye opener for the

student nurses to deeply feel the true impact of poverty. This activity also served as an

opportunity for them to enhance their critical thinking and socialization to understand and

somewhat abate a family’s certain condition.

Luigi Miguel H. de Jesus

As I was exposed in the community for almost 9 days, I’ve encountered a lot of

people and I had the chance to assess either pregnant women, sick children or

hypertensive individuals. I had the chance to see the deficits, threats to health of the

family we have adopted. I also learned how to properly assess a house and its family

members, on how important health is with the family.

Through interacting with the family we adopted, I’ve implied different nursing

interventions taught to us, we had health teachings to promote health and prevent

illness, and also we cleaned the environment together with them to maintain proper

management of the surroundings.

In the community, we are able to meet the health needs of the people in our own

little ways; we are able to help them even in small ways. With that, I have learned that

nursing is not just a profession taught to gain income rather it is giving compassion and

service to our countrymen. I also learned a lot in the different techniques on how to

establish rapport to families and how to teach them regarding family planning, proper

hygiene and prevention of communicable diseases. I’ve learned that many of us are

lacking knowledge regarding promotive and preventive measures to maintain good

health, so it is indeed necessary for us nurses to render care and give appropriate

interventions and management for them to achieve health.

To sum it all up, in my exposure in the community, I’ve learned so much on how

to be a competent community health nurse through the experiences I had.

-Florence Ancel Estrada

I realized the importance of having a stable job in order to adequately provide the

individuals needs of family members. It is also equally important to plan on how many

children that the couple could support with their present resources. I have also

pondered on the family’s situation which made me thankful n where I am right now.

Discrimination aside, I appreciate the efforts of my parents in providing me all that they

could give for me to have a better future. It has been seen by our group how the

children are undernourished and how inadequate their housing condition is. This has

made me realize the implications on what could happen if a family would not be able to

meet their individual needs. The children are always the one who suffers greatly for their

health and education are always compromised with such poor condition. It must be

responsibility of both parents to give their best in supporting their children. I have been

and still fortunate that parents had given me the opportunity to be educated even

though they are having difficulties in working. This made me realize that as a student

nurse. I could help change the community by exerting efforts to educate the families on

how to improve their condition amidst the lack of financial resources. It is true, indeed

that the primary responsibility in shaping an individual’s value of health comes from their

own families.

Being a PHN is also like handling a patient in a hospital, the only difference is that you

handle the whole family itself that you adopted. And the main goal is not just curing the

patient but also helping the family in preventing other potential problems that may arise,

and to also help them in coping from the instances in this fast paced world.

Mary Angelica Teoffy R. Libres

Through this experience, I have learned, discovered, and appreciated many

things. I have learned the importance of proper communication in dealing with the family

or other individuals and I also learned the importance of health teachings and how it can

affect the behavior and viewpoints of the family. Since the family are total strangers,

importance has to be emphasized on building trust, this may be a vital point in

coordinating with the family and in achieving the plans you have made with the family.

Since the period of the home visits consists only of a few days, it is important to give

your best in achieving self-reliance and also compliance to every health teaching given.

Compliance is an important thing I saw through this experience, seeing the family have

a change in behaviour even without reminding them is a something when achieved very

satisfying.

There are so much to learn in immersing yourself in an economically depressed

area but the most important thing is to be thankful with our condition in life because not

all people experiences the good life we have.

Daniel T. Palcis

Community Health Nursing is not a simple act or Nursing service rendered by either Registered

Nurses or Student Nurses. The primary objective of community Health Nursing in a large sense

is to promote the primary level of prevention, Health promotion, and also continuation of Health

care from the Hospital.

Community Health Nursing provides awareness and knowledge regarding the current

health situation of he community. As student Nurses, and as members of the health care team,

our responsibility is to promote and provide quality care. Even if we are still student nurses, we

already have the capacity to change, manipulate or improve the health situation of the

community. We should always take part and take in to consideration all of the nursing tasks that

we perform. Student nurses should love their craft or the art of nursing per se in order to provide

efficient nursing care.

The community health should be one of the primary objectives of a nurse. A healthy

mind and body contributes to the over-all heath of a person. As student nurses we should

always take part and never ignore the current over-all status of the community because a

healthy community also reflects the health service provided by the health sectors or providers.

Preciosa C. Valencia

IX. SOCIOGRAM:

This chapter illustrates graphic representation of the several home visits made, including

the interactions of the student nurses with the families, the assessment, planning, interventions

and evaluation done.

Legends:

Student Nurses Implementations

Griffin Family Health Teachings

Home Satisfaction

Assessment & Rapport

Nursing Interventions

Finding a family to fit the criteria, or are more than willing to be a part of the student

nurses’ education is quite of a dilemma. The student nurses had a hard time doing so, but

all complaints dissolved when they have found one.

The student nurses firstly, established rapport with family they chose to study. On the

succeeding days, health teachings were dispensed, thorough assessment and nursing

interventions were done and implementations to address problems were executed to help

alleviate the condition of the family, even just for a bit.

Finally, on the last day of visit they’ve evaluated each problem’s progress in terms of its

degree compared to their first day of visit and in here they’ve found out that some problems

such as personal hygiene and home environment had improved, leading to an increased

family satisfaction.

X. SPOT MAP AND DOCUMENTATION

FLOOR PLAN

Entrance

Backyard/Garden

Comfort Room

Kitchen

Bedroom /Living Room

Small Garden

Door

Window

Bedroom/ Livingroom

Kitchen

Comfort Room

Bed

Cooking Area

Wall

Griffin family’s humble abode

Interview with Mother Lois

Cookware devoid of cooking facility

Entertainment corner

The comfort room where laundry is done

Homemade cooking facility using charcoal or wood

Wound Dressing

Aftermath of an unattended cooking

Wound Dressing Part II

Vital signs taking

The house’s only window

Stewie taking a bath on the heat of summer

Coolness! Hairdressing stint for Meg

The Griffin family with the student nurses

Sweeping the floor.

The student nurse with some home essentials for the family.Meg also in for a refreshing bath

XI. BIBLIOGRAPHY

Untalan, A. Concepts and Guidelines in COPAR. 1st ed. Manila: Educational Publishing House,

2005.

Maglaya, A. Nursing Practice in the Community. Marikina City: Argonauta Corp., 2004.

Cuevas, F. et. al. Public Health Nursing in the Philippines. 10th ed. Philippines:2007

http://wisdomquotes.comhttp://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htmhttp://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htm

Handouts from:

Primary Health Care II (2007-2008)

http://psychology.about.com/od/theoriesofpersonality/a/psychosocial.htm

http://psychology.about.com/od/theoriesofpersonality/ss/psychosexualdev.htm

http://wisdomquotes.com/

Family Case Analysis 2

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